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Abstract: SA-PO472

Safety and Efficacy of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RAs) Among Patients with Type 2 Diabetes Mellitus (T2DM) and Advanced CKD and ESKD: A Systematic Review and Meta-Analysis

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Krisanapan, Pajaree, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Sanpawithayakul, Kanokporn, Thammasat University Hospital, Khlong Nueng, Pathum Thani, Thailand
  • Pattharanitima, Pattharawin, Thammasat University Faculty of Medicine, Khlong Nueng, Pathum Thani, Thailand
  • Thongprayoon, Charat, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Tangpanithandee, Supawit, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Miao, Jing, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Mao, Michael A., Mayo Clinic in Florida, Jacksonville, Florida, United States
  • Craici, Iasmina, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Cheungpasitporn, Wisit, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

Evidence supporting the use of GLP-1RAs in T2DM patients and advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) is scarce.

Methods

A literature search was conducted using MEDLINE, EMBASE, and Cochrane Database from inception through February 2023. The protocol for this review was registered in the International Prospective Register of Systematic Reviews (CRD 42023398452). Clinical trials and cohort studies reporting safety or efficacy outcomes of GLP-1RAs in adult patients with T2DM and advanced CKD (stage 5 CKD and ESKD) were included. Outcome measures included mortality, cardiovascular, blood glucose, and weight. Adverse events were assessed for safety. Estimates were pooled using random-efffects meta-analysis model.

Results

Eight studies (5 trials and 3 cohort studies) consisting of 27,639 patients with a median follow-up of 3 months (IQR 3, 12) were included in this meta-analysis. There was no difference in one-year mortality outcomes, but one cohort study found a significant long-term reduction in all-cause mortality with GLP-1RAs (HR 0.7; 95% CI 0.6, 0.9). GLP-1RAs significantly reduced cardiothoracic ratio (standardized mean difference, SMD of -1.2%; 95% CI -2.0, -0.4) and pro-BNP (SMD -335.9 pmol/L; 95% CI -438.9, -232.8), but did not significantly decrease systolic blood pressure compared to controls. GLP-1RAs significantly reduced mean blood glucose (SMD -1.1 mg/dL; 95% CI -1.8, -0.3) but not maximum blood glucose, blood glucose fluctuation, or HbA1c. GLP-1RAs resulted in significant weight loss (SMD -2.2 kg; 95% CI -2.9, -1.5). In term of safety, GLP-1RAs were associated with 3.8- and 35.7-time higher risk of nausea and vomiting, respectively, but were not significantly associated with higher risk of hypoglycemia.

Conclusion

Our study provides evidence supporting the safety and efficacy of GLP-1RAs among T2DM patients with advanced CKD and ESKD. While GLP-1RAs may have GI side effects, they demonstrate significant improvement on cardiovascular outcomes, blood glucose control, and weight reduction.